U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES ∙ National Institutes of Health
NIDCD Fact Sheet | Voice, Speech, and Language
Autism Spectrum Disorder:
Communication Problems in Children
What is autism spectrum disorder?
Autism spectrum disorder (ASD) is a developmental
disability that can cause significant social, communication,
and behavioral challenges. The term “spectrum” refers
to the wide range of symptoms, skills, and levels of
impairment that people with ASD can have.
ASD affects people in different ways and can range from
mild to severe. People with ASD share some symptoms,
such as difficulties with social interaction, but there are
differences in when the symptoms start, how severe
they are, the number of symptoms, and whether other
problems are present. The symptoms and their severity
can change over time.
The behavioral signs of ASD often appear early in
development. Many children show symptoms by
12 months to 18 months of age or earlier.
Who is affected by ASD?
ASD affects people of every race, ethnic group, and
socioeconomic background. It is four times more common
among boys than among girls. The Centers for Disease
Control and Prevention (CDC) estimates that about
1 in every 54 children in the U.S. has been identified as
having ASD.
How does ASD affect communication?
The word “autism” has its origin in the Greek word
“autos,” which means “self.” Children with ASD are
often self-absorbed and seem to exist in a private
NIDCD...Improving the lives of people with communication disorders
world in which they have limited ability to successfully
communicate and interact with others. Children with
ASD may have difficulty developing language skills
and understanding what others say to them. They
also often have difficulty communicating nonverbally,
such as through hand gestures, eye contact, and facial
expressions.
The ability of children with ASD to communicate and
use language depends on their intellectual and social
development. Some children with ASD may not be able to
communicate using speech or language, and some may
have very limited speaking skills. Others may have rich
vocabularies and be able to talk about specific subjects
in great detail. Many have problems with the meaning
and rhythm of words and sentences. They also may be
unable to understand body language and the meanings
of different vocal tones. Taken together, these difficulties
affect the ability of children with ASD to interact with
others, especially people their own age.
Below are some patterns of language use and behaviors
that are often found in children with ASD.
} Repetitive or rigid language. Often, children with
ASD who can speak will say things that have no
meaning or that do not relate to the conversations they
are having with others. For example, a child may count
from one to five repeatedly amid a conversation that
is not related to numbers. Or a child may continuously
repeat words he or she has heard—a condition called
echolalia. Immediate echolalia occurs when the child
repeats words someone has just said. For example,
the child may respond to a question by asking the
 same question. In delayed echolalia, the child repeats
words heard at an earlier time. The child may say
“Do you want something to drink?” whenever he or
she asks for a drink. Some children with ASD speak
in a high-pitched or sing-song voice or use robot-like
speech. Other children may use stock phrases to start a
conversation. For example, a child may say, “My name
is Tom,” even when he talks with friends or family.
Still others may repeat what they hear on television
programs or commercials.
} Narrow interests and exceptional abilities. Some
children may be able to deliver an in-depth monologue
about a topic that holds their interest, even though they
may not be able to carry on a two-way conversation
about the same topic. Others may have musical
talents or an advanced ability to count and do math
calculations. Approximately 10 percent of children with
ASD show “savant” skills, or extremely high abilities
in specific areas, such as memorization, calendar
calculation, music, or math.
} Uneven language development. Many children with
ASD develop some speech and language skills, but
not to a normal level of ability, and their progress is
usually uneven. For example, they may develop a strong
vocabulary in a particular area of interest very quickly.
Many children have good memories for information just
heard or seen. Some may be able to read words before
age five, but may not comprehend what they have read.
They often do not respond to the speech of others and
may not respond to their own names. As a result, these
children are sometimes mistakenly thought to have a
hearing problem.
} Poor nonverbal conversation skills. Children with
ASD are often unable to use gestures—such as pointing
to an object—to give meaning to their speech. They
often avoid eye contact, which can make them seem
rude, uninterested, or inattentive. Without meaningful
gestures or other nonverbal skills to enhance their
oral language skills, many children with ASD become
frustrated in their attempts to make their feelings,
thoughts, and needs known. They may act out
their frustrations through vocal outbursts or other
inappropriate behaviors.
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How are the speech and language
problems of ASD treated?
If a doctor suspects a child has ASD or another
developmental disability, he or she usually will refer
the child to a variety of specialists, including a speech-
language pathologist. This is a health professional trained
to treat individuals with voice, speech, and language
disorders. The speech-language pathologist will perform
a comprehensive evaluation of the child’s ability to
communicate, and will design an appropriate treatment
program. In addition, the speech-language pathologist
might make a referral for a hearing test to make sure the
child’s hearing is normal.
Teaching children with ASD to improve their communication
skills is essential for helping them reach their full potential.
There are many different approaches, but the best treatment
program begins early, during the preschool years, and is
tailored to the child’s age and interests. It should address
both the child’s behavior and communication skills and offer
regular reinforcement of positive actions. Most children with
ASD respond well to highly structured, specialized programs.
Parents or primary caregivers, as well as other family
members, should be involved in the treatment program so
that it becomes part of the child’s daily life.
For some younger children with ASD, improving speech
and language skills is a realistic goal of treatment. Parents
and caregivers can increase a child’s chance of reaching
this goal by paying attention to his or her language
development early on. Just as toddlers learn to crawl
before they walk, children first develop pre-language
skills before they begin to use words. These skills include
using eye contact, gestures, body movements, imitation,
and babbling and other vocalizations to help them
communicate. Children who lack these skills may be
evaluated and treated by a speech-language pathologist to
prevent further developmental delays.
For slightly older children with ASD, communication
training teaches basic speech and language skills, such as
single words and phrases. Advanced training emphasizes
the way language can serve a purpose, such as learning to
hold a conversation with another person, which includes
staying on topic and taking turns speaking.
Some children with ASD may never develop oral speech
and language skills. For these children, the goal may be
learning to communicate using gestures, such as sign
language. For others, the goal may be to communicate by
means of a symbol system in which pictures are used to
convey thoughts. Symbol systems can range from picture
boards or cards to sophisticated electronic devices that
generate speech through the use of buttons to represent
common items or actions.
What research is being conducted to
improve communication in children
with ASD?
The federal government’s Autism CARES Act of 2014
brought attention to the need to expand research and
improve coordination among all of the components of the
National Institutes of Health (NIH) that fund ASD research.
These include the National Institute of Mental Health
(NIMH), along with the National Institute on Deafness
and Other Communication Disorders (NIDCD), the Eunice
Kennedy Shriver National Institute of Child Health and
Human Development (NICHD), the National Institute of
Environmental Health Sciences (NIEHS), the National Institute
of Neurological Disorders and Stroke (NINDS), the National
Institute of Nursing Research (NINR), and the National Center
for Complementary and Integrative Health (NCCIH).
Together, five institutes within the NIH (NIMH, NIDCD,
NICHD, NIEHS, and NINDS) support the Autism Centers
of Excellence (ACE) (https://www.nichd.nih.gov/research/
supported/ace), a program of research centers and networks
at universities across the country. Here, scientists study a
broad range of topics, from basic science investigations
that explore the molecular and genetic components of
ASD to translational research studies that test new types of
behavioral therapies. Some of these studies involve children
with ASD who have limited speech and language skills, and
could lead to testing new treatments or therapies. You can
visit the NIH Clinical Trials website (https://clinicaltrials.gov/)
and enter the search term “autism” for information about
current trials, their locations, and who may participate.
The NIDCD supports additional research to improve
the lives of people with ASD and their families
(https://www.nidcd.nih.gov/research/autism-research-and-
nidcd). An NIDCD-led workshop focused on children with
ASD who have limited speech and language skills (https://
www.nidcd.nih.gov/research/workshops/nonverbal-school-
aged-children-autism/2010), resulting in two groundbreaking
articles.1 Another NIDCD workshop on measuring language
in children with ASD (https://www.nidcd.nih.gov/research/
workshops/language-benchmarks-children-autism/2007)
resulted in recommendations calling for a standardized
approach for evaluating language skills. The benchmarks
will make it easier, and more accurate, to compare the
effectiveness of different therapies and treatments.
NIDCD-funded researchers in universities and organizations
across the country are also studying:
} Ways to reliably test for developmental delays in speech
and language in the first year of life, with the ultimate
goal of developing effective treatments to address the
communication challenges faced by many with ASD.
} How parents can affect the results of different types of
language therapies for children with ASD.
} Enhanced ways to improve communication between
children with and without ASD. This could involve a
communication board with symbols and pictures, or even
a smartphone app.
} Techniques to help researchers better understand how
toddlers with ASD perceive words, and the problems they
experience with words.
} Cost-effective ways to prevent or reduce the impact of
conditions affecting speech, language, and social skills in
high-risk children (for example, younger siblings of children
with ASD).
} The development of software to help people with ASD
who struggle with speech to communicate complex
thoughts and interact more effectively in society.
1 Kasari, C., Brady, N., Lord, C., & Tager-Flusberg, H. (2013). Assessing
the minimally verbal school-aged child with autism spectrum disorder.
Autism Research, 6(6), 479–493. doi: 10.1002/aur.1334.Review.
Retrieved November 8, 2016, from https://www.ncbi.nlm.nih.gov/
pubmed/24353165.
Tager-Flusberg, H., & Kasari, C. (2013). Minimally verbal school-aged
children with autism spectrum disorder: the neglected end of the
spectrum. Autism Research, 6(6), 468–478. doi: 10.1002/aur.1329.
Review. Retrieved November 8, 2016, from https://www.ncbi.nlm.nih.
gov/pubmed/24124067.
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Where can I find additional
information about ASD?
Information from other NIH Institutes and Centers
that participate in ASD research is available on the NIH
Health Information page (https://www.nih.gov/health-
information) by searching on the term “autism.”
In addition, the NIDCD maintains a directory of
organizations that provide information on the normal
and disordered processes of hearing, balance, taste,
smell, voice, speech, and language. Visit the NIDCD
website at https://www.nidcd.nih.gov/directory to search
the directory.
More NIDCD fact sheets on Voice, Speech, and
Language:
} Speech and Language Developmental Milestones
} Specific Language Impairment
Visit the NIDCD website at https://www.nidcd.nih.gov to
read, print, or download fact sheets.
For more information, contact us at:
NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free voice: (800) 241-1044
Toll-free TTY: (800) 241-1055
Email: nidcdinfo@nidcd.nih.gov
https://www.nidcd.nih.gov
Follow the NIDCD on Twitter at @NIDCD
The NIDCD supports and conducts research and
research training on the normal and disordered
processes of hearing, balance, taste, smell, voice,
speech, and language and provides health information,
based upon scientific discovery, to the public.
Autism Spectrum Disorder:
Communication Problems in
Children
NIH Pub. No. 97–4315
April 2020
NIH...Turning Discovery Into Health®